Coronary embolism causing myocardial infarction after heart valve surgery

Andrej Preveden; Mila Kovačević; Stamenko Šušak; Aleksandar Redžek; Lazar Velicki

doi:10.2298/VSP180809180P

Andrej Preveden University of Novi Sad, Faculty of medicineInstitute for cardiovascular diseases of Vojvodina
Mila Kovačević University of Novi Sad, Faculty of medicine Institute for cardiovascular diseases of Vojvodina
Stamenko Šušak University of Novi Sad, Faculty of medicine Institute for cardiovascular diseases of Vojvodina
Aleksandar Redžek University of Novi Sad, Faculty of medicine Institute for cardiovascular diseases of Vojvodina
Lazar Velicki University of Novi Sad, Faculty of medicine Institute for cardiovascular diseases of Vojvodina

DOI: https://doi.org/10.2298/VSP180809180P

Keywords: coronary vessels;, embolism;, heart valves diseases;, myocardial infarction;, postoperative complications;, resuscitation;, treatment outcome

Abstract

Introduction. Coronary embolism can rarely be a cause of myocardial infarction. It is usually associated with atrial fibrillation, dilated cardiomyopathy, bacterial endocarditis and underlying hypercoagulable state, as well as heart surgery. Case report. We reported a case of a patient with severe mitral and tricuspid regurgitation, with no underlying coronary artery disease. The patient underwent heart valve surgery, and the immediate postoperative course was uneventful. Five days after the operation, the patient sustained cardiac arrest, which was followed by a successful cardiopulmonary resuscitation. Electrocardiography showed atrial fibrillation with a significant ST segment elevation in the inferior leads. Urgent coronary angiography revealed a total occlusion of the right coronary artery, thus percutaneous coronary intervention was performed, after which flow restoration through the artery was achieved. The patient was discharged with triple antithrombotic therapy on the 20th postoperative day. Conclusion. Heart surgery could be followed by unexpected and potentially fatal complications, coronary embolism being one of them. In such case, the prompt and adequate reaction by the whole medical team is crucial for a patient's survival and recovery.

References

Prizel KR, Hutchins GM, Bulkley BH. Coronary artery embo-lism and myocardial infarction. Ann Intern Med 1978; 88(2): 155‒61.

Shibata T, Kawakami S, Noguchi T, Tanaka T, Asaumi Y, Kanaya T, et al. Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Attributable to Coronary Ar-tery Embolism. Circulation 2015; 132(4): 241‒50.

Popovic B, Agrinier N, Bouchahda N, Pinelli S, Maigrat CH, Metzdorf PA, et al. Coronary Embolism Among ST-Segment-Elevation Myocardial Infarction Patients: Mecha-nisms and Management. Circ Cardiovasc Interv 2018; 11(1): e005587.

Kalçık M, Yesin M, Gürsoy MO, Karakoyun S, Özkan M. Treat-ment strategies for prosthetic valve thrombosis-derived coronary embolism. JACC Cardiovasc Interv 2015; 8(5): 756‒7.

Kotooka N, Otsuka Y, Yasuda S, Morii I, Kawamura A, Miyazaki S. Three cases of acute myocardial infarction due to coro-nary embolism: treatment using a thrombus aspiration de-vice. Jpn Heart J 2004; 45(5): 861‒6.

Hernández F, Pombo M, Dalmau R, Andreu J, Alonso M, Albarrán A, et al. Acute coronary embolism: angiographic diagnosis and treatment with primary angioplasty. Catheter Cardio-vasc Interv 2002; 55(4): 491‒4.

Hiltrop N, Bennett J, Desmet W. Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature. Catheter Cardio-vasc Interv 2017; 89(1): 78‒92.

Zegdi R, Jouan J, Fabiani JN, Deloche A. Injury to the circum-flex coronary artery following mitral valve repair. Eur J Cardiothorac Surg 2007; 31(4): 740.

Smith BB, Smith MM, Rehfeldt KH. Iatrogenic Right Coro-nary Artery Occlusion Following Tricuspid Valve Repair: Case Report of a Rare but Recognized Complication. A A Case Rep 2017; 8(2): 39‒41.

Miura Y, Takeuchi R, Terai Y, Nakai M, Yamazaki F, Onodera T, et al. Right ventricular infarction caused by tricuspid ring annuloplasty. Gen Thorac Cardiovasc Surg 2017; 65(8): 463‒5.

Nakajima H, Ikari Y, Kigawa I, Kitamura T, Hatori M, Tooda E, et al. Rapid diagnosis and management of intraoperative myocardial infarction during valvular surgery: using in-traoperative transesophageal echocardiography followed by emergency coronary artery bypass grafting without coro-nary angiography. Echocardiography 2005; 22(10): 834‒8.

Meursing DF, Boonswang NA, Dobrilovic N, Wait MA. Perioper-ative myocardial infarction secondary to dynamic circum-flex coronary artery occlusion after mitral valve repair. Tex Heart Inst J 2006; 33(1): 85‒7.

Wang LW, Omari A, Muller DW, Jacobs NH, Subbiah RN. Coronary artery embolization after successful surgical abla-tion of atrial fibrillation. Circulation 2013; 127(8): 960‒1.

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial in-farction. Eur Heart J 2012; 33(20): 2551‒67.